Provider Demographics
NPI:1194013789
Name:GERAGHTY, KRISTINA (OTR)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:GERAGHTY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:MELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-1121
Mailing Address - Country:US
Mailing Address - Phone:845-430-1616
Mailing Address - Fax:
Practice Address - Street 1:690 N BROADWAY
Practice Address - Street 2:GL2
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-2417
Practice Address - Country:US
Practice Address - Phone:914-686-3116
Practice Address - Fax:914-686-3082
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0200X
NY016752-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics